Latent class analysis of substance use: comparison of two American Indian reservation populations and a national sample

Tribal Reservation Adolescent Connections Study: A study protocol using mixed methods for examining social networks and associated outcomes among American Indian youth on a Northern Plains reservation

BACKGROUND

Rich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation.

METHODS

This mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined.

DISCUSSION

This innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

Use of latent class analysis as a method of assessing the physical activity level, sedentary behavior and nutritional habit in the adolescents' lifestyle: A scoping review

BACKGROUND

Currently, adolescents' lifestyle is commonly characterized by physical inactivity, sedentary behavior, and inappropriate eating habits in general. A person-oriented approach as Latent Class Analysis (LCA) can offer more insight than a variable-centered approach when investigating lifestyle practices, habits, and behaviors of adolescent population.

OBJECTIVE

The aim of the present study was to assess which variables are mostly used to represent the physical activity level, sedentary behavior SB) and nutritional habit in the adolescents' lifestyle in studies that used the LCA.

DESIGN

Scoping review.

METHODS

The study was a performed in accordance with the proposed criteria for systematic reviews and meta-analyses-Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42018108444). The original articles were searched in MEDLINE/PubMed, Scopus, ScienceDirect, Web of Science, PsycINFO, and SPORTdiscus. The Quality Assessment Tool analyzed the risk of bias of the included studies.

RESULTS

30 original articles were selected. The physical activity level (28 studies), SB and nutritional habits (18 studies) were the most common variable used to evaluate the adolescent's lifestyle by LCA model. Specifically, physical inactivity and high SB were the manifest variables with higher frequency in the negative latent classes (LCs) in adolescent girls. On the other hand, physical exercises and sports were activities more commonly labeled as positive LCs.

CONCLUSIONS

The LCA models of the most of selected studies showed that physical inactivity, high SB were the most common in the LCs with negative characteristics of the adolescents' lifestyle. Better understanding the results of analyzes of clusters of multivariate behaviors such as the LCA can help to create more effective strategies that can make the lifestyle of adolescents healthier.

Conjoint adolescent developmental trajectories of alcohol and marijuana use and early adult outcomes among North American Indigenous people

OBJECTIVE

The current study examined the developmental interrelationships between alcohol and marijuana use trajectories from ages 10 to 18 years in a sample of North American Indigenous adolescents. Distinct co-use groups were formed to create profiles of young adult outcomes.

METHOD

Dual group-based trajectory models of marijuana and alcohol frequency were estimated using data from a longitudinal community-based participatory study of Indigenous adolescents from the upper Midwest and Canada. Joint probabilities were used to create co-use groups, and profiles were created using early adult (Mean Age - 26.28 years) outcomes.

RESULTS

Four joint trajectory groups were identified: 1) no marijuana and no/low alcohol use (34.4%), 2) mid-onset alcohol only (14%), 3) mid-onset co-use starting at age 13 (24%), and 4) early-onset co-use starting at age 11 (22%). High probabilities existed that adolescents would use marijuana early if they began drinking alcohol at the youngest ages, and that adolescents would not use marijuana if they drank infrequently or delayed drinking until mid-adolescence. Adult outcomes were poorer for the early- and mid-onset co-use groups, but there were few differences between the no/low use and alcohol-only groups.

CONCLUSION

Co-use of marijuana and alcohol was associated with poorer outcomes in early adulthood, particularly for the group with an earlier age of onset. Abstaining from either substance in adolescence was associated with better outcomes.

Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017

BACKGROUND

Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia.

METHODS

This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied.

RESULTS

The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7).

CONCLUSION

Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.

Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents

North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.

Differential typologies of current substance use among Black and White high-school adolescents: A latent class analysis

Black and White adolescents demonstrate different prototypical profiles (i.e., typologies) of substance use, with Blacks demonstrating lower risk for concurrent use of two or more substances. Despite knowledge of these differences, typologies of adolescent substance use identified by person-centered methods, such as latent class analysis, have not characterized profiles by racial group. The current study examined typologies of substance use among Black and White youth separately using person-centered methods to identify common patterns of substance use among subjects. Data were drawn from a 5-year parent study examining adolescent health outcomes. The current study examined high-school aged White (n = 7271, 45.4% male) and Black youth (n = 1301, 40.1% male) who reported past-30-day frequency of cigarette, alcohol, marijuana, inhalant, and other drug use. Latent class analysis was used to examine substance use typologies among each group adjusting for grade and sex. Black and White youth demonstrated different typologies such that four typologies emerged among Blacks: Non-Use (87.8%), Alcohol and Marijuana Use (6.3%), Alcohol, Marijuana, and Cigarette Use (3.8%), and Frequent Polysubstance Use (2.0%). Conversely, five typologies emerged among Whites: Non-Use (73.4%), Predominant Alcohol Use (13.9%), Alcohol, Marijuana, and Cigarette Use (9.4%), Moderate Polysubstance Use (1.6%), and Frequent Polysubstance Use (1.7%). Findings suggest that Black and White youth engage in similar rates of concurrent substance use. Given that Black youth face greater risk for adverse consequences from substance use, prevention efforts are needed to prevent related health disparities related to concurrent substance use.

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees

BACKGROUND

The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors.

OBJECTIVE

The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees.

RESEARCH DESIGN

We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement.

MEASURES

Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes.

RESULTS

We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs.

CONCLUSIONS

Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.

Latent Classes of Substance Use Among American Indian and White Students Living on or Near Reservations, 2009-2013

OBJECTIVES

American Indian adolescents who reside on or near reservations report higher levels of substance use than adolescents in other racial/ethnic groups. Little research has addressed patterns of use, which have important implications for prevention and treatment planning. The objective of our study was to describe substance use among a large, population-based sample of American Indian and white students who lived on or near reservations.

METHODS

We obtained data from 4964 students in grades 7-12 attending 46 schools on or near reservations throughout the United States during 4 academic years (2009-2013). Measures assessed current substance use for alcohol, heavy drinking, marijuana, cigarettes, inhalants, and other drugs. We used latent class analysis to identify patterns of substance use by grade group (grades 7-8 and grades 9-12) and race (American Indian or white).

RESULTS

For American Indians in both grade groups, we found 4 classes of substance use (in order of size): (1) nonusers; (2) marijuana and cigarette users; (3) alcohol, marijuana, and cigarette users; and (4) polysubstance users. For white students, we found 2 classes (nonusers and polysubstance users) among younger students and 4 classes (nonusers; alcohol, marijuana, and cigarette users; alcohol and cigarette users; and polysubstance users) among older students.

CONCLUSION

We found significant differences in substance use patterns, especially at younger ages, between reservation American Indian students and white students attending the same schools. Combinations of substances used by American Indian adolescents were most likely to include marijuana, as compared with alcohol for white adolescents. Identifying subpopulations of users allows the design of interventions that will more efficiently and effectively address prevention and treatment needs of groups of individuals than would a one-size-fits-all approach.

Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity

Substance use during adolescence is a public health concern due to associated physical and behavioral health consequences. Such consequences are amplified among concurrent substance users. Although sex and racial/ethnic differences in single-substance use have been observed, the current literature is inconclusive as to whether differences exist in the prevalence of concurrent use. The current study used data from the 2011-2014 National Survey on Drug Use and Health to examine typologies (single and concurrent patterns) of alcohol, marijuana, and cigarette use among current adolescent users age 12-18 by sex and race/ethnicity. Participants were 14,667 White, Hispanic, African American, Asian, and Native American adolescents. The most common typology was alcohol only, followed by concurrent use of alcohol and marijuana. Weighted prevalence estimates indicated that adolescent females were more likely to be current users of alcohol only, whereas male adolescents were more likely to belong to all other typologies. Compared to Whites, racial/ethnic minorities had larger proportions of marijuana only users and were generally less likely than or equally likely to be concurrent users. One exception was for African American adolescents, who were more likely to be alcohol and marijuana users than their White counterparts. Results suggest that concurrent substance use is common among U.S. adolescents, making up over 40% of past-month use, but typologies of use vary by sex and race/ethnicity. Preventive interventions should consider all typologies of use rather than only single substance exposures and address patterns of use that are most pertinent to adolescents based on sex and race/ethnicity.

Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities

BACKGROUND

Little is known about characteristic profiles of substance use - and their individual- and neighborhood-level correlates - among high-risk youth.

OBJECTIVES

To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors.

METHODS

Individual-level measures came from screening surveys administered to youth aged 14-24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership.

RESULTS

Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant.

CONCLUSION

Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.

Substance Use Profiles of Urban American Indian Adolescents: A Latent Class Analysis

A growing majority of American Indian adolescents now live in cities and are at high risk of early and problematic substance use and its negative health effects.

OBJECTIVE

This study used latent class analysis to empirically derive heterogeneous patterns of substance use among urban American Indian adolescents, examined demographic correlates of the resulting latent classes, and tested for differences among the latent classes in other risk behavior and prosocial outcomes.

METHOD

The study employed a representative sample of 8th, 10th, and 12th grade American Indian adolescents (n = 2,407) in public or charter schools in metropolitan areas of Arizona in 2012. Latent class analysis examined eight types of last 30 day substance use.

RESULTS

Four latent classes emerged: a large group of "nonusers" (69%); a substantial minority using alcohol, tobacco, and/or marijuana [ATM] (17%); a smaller group of polysubstance users consuming, alcohol, tobacco, marijuana, other illicit drugs, and prescription or OTC drugs in combination (6%); and a "not alcohol" group reporting combinations of tobacco, marijuana, and prescription drug use, but rarely alcohol use (4%). The latent classes varied by age and grade level, but not by other demographic characteristics, and aligned in highly consistent patterns on other non-substance use outcomes. Polysubstance users reported the most problematic and nonusers the least problematic outcomes, with ATM and "not alcohol" users in the middle.

CONCLUSIONS

Urban AI adolescent substance use occurs in three somewhat distinctive patterns of combinations of recent alcohol and drug consumption, covarying in systematic ways with other problematic risk behaviors and attitudes.

Dynamic Patterns of Adolescent Substance Use: Results From a Nationally Representative Sample of High School Students

OBJECTIVE

Use of tobacco, alcohol, marijuana, and other drugs increases during the high school years, yet little is known about individual patterns over time, particularly patterns of contemporaneous multiple-substance use. This study examined trajectories of contemporaneous substance use and how individual and social factors differentially predict patterns of substance use.

METHOD

Longitudinal trajectories of substance use were examined in a nationally representative sample of students (N = 2,512) over a 3-year period (10th through 12th grades) using latent class analysis. Individual, parental, and peer risk factors in 10th grade were examined in relation to membership in trajectory classes.

RESULT

A five-class model was identified: nonusers (45.5%); tobacco, alcohol, and other drug users (9.2%); alcohol and other drug users (9.2%); increasing multiple-substance users (16.7%); and decreasing multiple-substance users (19.4%). Depressive symptoms at baseline were associated with a higher likelihood of membership in all classes except the increasing multiple-substance-user class, but the association becomes insignificant when social influence factors were adjusted. Parental-monitoring knowledge was associated with a lower likelihood of membership in all classes except increasing multiple-substance-user class, whereas perceived parental disapproval was associated with a lower likelihood of membership in the tobacco, alcohol, and other drug user class. Peer substance use was associated with a higher likelihood of membership in each of the substance use classes.

CONCLUSIONS

The identified longitudinal profiles highlight the pervasiveness and dynamic patterns of contemporaneous multiple-substance use during 10th through 12th grades. Negative peer influence increased risk, whereas positive parenting behaviors decreased risk. The findings are consistent with the need to foster social influences and protective factors against adolescent substance use.

What Social Bonds have the Greatest Influence on Patterns of Substance Use among Child-Welfare-Involved Youth?

Child-welfare-involved youth may lack protective social bonds that could reduce their risk of substance use. We investigated whether caregiver, school, or peer bonds predict distinct patterns of substance use among child-welfare-involved youth. The sample included 720 participants in the National Survey of Child and Adolescent Well-Being II. Latent class analysis (LCA) and the three-step approach to incorporate indicator variables onto the latent classes were used. We found the following classes: (1) severe polysubstance use; (2) moderate polysubstance use; and (3) low use. Youth bonded to primary caregivers were less likely to be severe polysubstance drug users, but caregiver bonds did not protect against moderate polysubstance use. School bonds protected against severe polysubstance and moderate polysubstance. Youth bonded to deviant peers were more likely to be in the severe polysubstance use and moderate polysubstance use classes. Interventions targeting child-welfare-involved youth need to account for social bonds' effect on substance use.

Sex differences in the latent class structure of alcohol use disorder: Does (dis)aggregation of indicators matter?

Many researchers have argued for a differential presentation of alcohol use disorder (AUD) between men and women. Latent class analysis is the most commonly used analytic technique for modeling AUD subcategories, and latent class analyses have supported a variety of class structures of AUD. This article examines whether these differential results are, in part, an artifact of whether researchers have (a) analyzed men and women in the same analysis and (b) aggregated item-level symptoms into AUD diagnostic criteria prior to analysis. These related methodological issues are examined using Wave 2 data from the National Epidemiologic Survey of Alcohol and Related Conditions (N = 22,177). Direct comparison of results when the sexes are modeled separately or together shows that women are classified differently depending on whether men are included in the analysis. A comparison of disaggregated item-level symptoms and aggregated AUD criteria suggests that aggregating data remove a subgroup, individuals who exhibit tolerance but are normative on all other AUD symptoms, which is of theoretical and clinical interest. Consequently, basic methodological issues that are rarely systematically studied appear to be important determinants of studies seeking to determine whether male and female alcoholism are structurally isomorphic.

Do physical abuse, depression, and parental substance use influence patterns of substance use among child welfare involved youth? Substance use misuse

To date studies have not explored patterns of substance use exclusively among youth in the child welfare system. Consequently, little is known about polysubstance use among child welfare-involved youth. This study aimed to explore whether physical abuse, parental substance use, depression, and demographic characteristics predict distinct patterns of substance use among child welfare-involved youth using latent class analysis (LCA). The sample included 822 11-17 year olds who participated in the National Survey of Child and Adolescent Well-being (NSCAW II) study between March 2008 and September 2009. We found the following three classes: (1) polysubstance use, (2) alcohol and marijuana use, and (3) low use. Older youth and youth who experienced physical abuse were at greater risk of being in the polysubstance use class, while living with a biological parent reduced the likelihood of polysubstance use class membership. Youth in the alcohol and marijuana use class were more likely to be older and depressed. Results from this study illuminate important targets for interventions.

Correlates and Consequences of Opioid Misuse among High-Risk Young Adults

Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses. Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days. Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantly associated with riskier opioid misuse trajectories. Conclusion. Young adults who reported more debilitating experiences as children and adolescents misused opioids longer and engaged in higher risk alternate modes of administering opioids. Data on decisions both to use and to alter a drug's form can be combined to describe patterns of misuse over time and predict important risk behaviors.

Latent class analysis of substance use among adolescents presenting to urban primary care clinics

BACKGROUND

Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting.

OBJECTIVES

This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups.

METHODS

Data came from patients, ages 12-18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership.

RESULTS

LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1.

CONCLUSION

Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

Patterns of physical activity, sedentary behavior, and diet in U.S. adolescents

OBJECTIVE

To identify patterns in adolescents' obesogenic behaviors and their relations to physical and psychological health.

METHODS

A nationally representative sample of 9,174 U.S. adolescents ages 11 to 16 years was surveyed on physical activity (PA), screen-based sedentary behavior (SB), frequency of consumption of healthy and unhealthy food items, weight status, weight control behavior, depression, physical symptoms, body dissatisfaction, overall health, and life satisfaction. Latent class analysis was used to identify patterns of PA, SB, and diet.

RESULTS

A model with three latent classes best fit the data: Class 1 with high PA and high fruit and vegetable intake and low SB and intake of sweets, soft drinks, chips, and fries; Class 2 with high SB and high intake of sweets, soft drinks, chips, and fries; and Class 3 with low PA, low fruit and vegetable intake, and low intake of sweets, chips, and fries. Membership in the three classes was related to age, gender, race/ethnicity, and socioeconomic status. In addition, members of Class 1 (26.5%) were more likely to be of normal weight status and to fare well on most of the other health indices; of Class 2 (26.4%) were less likely to be trying to lose weight but scored poorly on the mental health indices; and of Class 3 (47.2%) were less likely to be underweight and reported greater body dissatisfaction.

CONCLUSIONS

Three prevalent patterns of adolescent obesogenic behaviors were identified and these patterns related to weight status, depression, and other indicators of physical and psychological health.

Prevalence and patterns of polysubstance use in a nationally representative sample of 10th graders in the United States

PURPOSE

The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students.

METHODS

A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524).

RESULTS

Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms.

CONCLUSIONS

The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.

Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors

BACKGROUND

Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections.

METHODS

Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV.

RESULTS

Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR=6.97, 95% CI=4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR=2.66, 95% CI=1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR=2.50, 95% CI=1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR=0.10, 95% CI=0.06-0.18), but no significant differences were found for HIV.

CONCLUSIONS

Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.

A latent class analysis of alcohol abuse and dependence symptoms among Puerto Rican youth

The study aim was to classify youths into homogenous groups based on their symptoms of Alcohol Abuse and Dependence. An NIDA-funded cross-sectional survey was administered to 622 middle and high school students in San Juan, Puerto Rico in 2000. Latent class analysis (LCA) examined the Alcohol Abuse and Dependence symptoms. Three distinct classes of drinkers were found: low (86.0% of sample), moderate (11.7% of sample), and high (2.3% of sample) severity classes which were distinguished by differing estimated probabilities of symptom reporting. The study has implications for the diagnosis of Alcohol Abuse and Dependence among Puerto Rican youths. Limitations are also noted.

Individual differences in problem drinking among tribal members from one first nation community

BACKGROUND

 Health disparities related to drinking in native communities are of concern. Although individuals living in native communities have high rates of problem drinking, there is also variability in their drinking levels. The authors conducted a test of a model of First Nation drinking risk that incorporates personality and psychosocial learning to examine its cross-cultural applicability. That model identifies a risk process thought to explain aspects of individual differences in both native problem drinking and non-native problem drinking. One implication of the theory is that positive alcohol expectancies mediate the influence of negative urgency (the tendency to act rashly when distressed) on problem drinking similarly for both cultures.

METHODS

 We administered questionnaires to a total of 211 First Nation people and 236 Caucasians.

RESULTS

 A structural modeling analysis of 211 First Nation people and 236 Caucasian people found that (i) personality, alcohol expectancy, and problem drinking measures were invariant across the 2 cultures and (ii) results consistent with the hypothesis that positive alcohol expectancies mediated the influence of negative urgency on problem drinking were also invariant across culture.

CONCLUSIONS

 The findings support the theory that personality traits and psychosocial learning are important determinants of problem drinking in First Nation people and Caucasians.

Patterns of polydrug use in Great Britain: findings from a national household population survey

BACKGROUND

Polydrug use potentially increases the likelihood of harm. As little is known about polydrug use patterns in the general population, it is difficult to determine patterns associated with highest likelihood.

METHODS

Latent class analysis was performed on nine illicit substance groups indicating past year use of cannabis, cocaine, amphetamines, ecstasy, LSD, mushrooms, amyl nitrate, tranquillisers and heroin or crack. Analyses were based on data from a large multi-stage probability sample of the population of Great Britain (n=8538) collected in 2000. Multinomial logistic regression was performed highlighting associations between classes, and demographic and mental health variables.

RESULTS

A three class solution best described patterns of polydrug use; wide range, moderate range, and no polydrug use. For males and young people, there was a significantly increased chance of being in the wide and moderate range polydrug use groups compared to the no polydrug use class. Hazardous drinking was more likely in the wide and moderate polydrug classes with odds ratios of 9.99 and 2.38 (respectively) compared to the no polydrug use class. Current smokers were more likely to be wide and moderate range polydrug users compared to the no polydrug use class with odds ratios of 4.53 and 5.85 respectively. A range of mental health variables were also related to class membership.

CONCLUSIONS

Polydrug use in Great Britain can be expressed as three distinct classes. Hazardous alcohol use and tobacco use were strongly associated with illicit polydrug use, polydrug use appeared to be significantly associated with mental health, particularly lifetime suicide attempts.

Modeling Relations Among Discrete Developmental Processes: A General Approach to Associative Latent Transition Analysis

To understand one developmental process, it is often helpful to investigate its relations with other developmental processes. Statistical methods that model development in multiple processes simultaneously over time include latent growth curve models with time-varying covariates, multivariate latent growth curve models, and dual trajectory models. These models are designed for growth represented by continuous, unidimensional trajectories. The purpose of this article is to present a flexible approach to modeling relations in development among two or more discrete, multidimensional latent variables based on the general framework of loglinear modeling with latent variables called associative latent transition analysis (ALTA). Focus is given to the substantive interpretation of different associative latent transition models, and exactly what hypotheses are expressed in each model. An empirical demonstration of ALTA is presented to examine the association between the development of alcohol use and sexual risk behavior during adolescence.

Social-ecological influences on patterns of substance use among non-metropolitan high school students

Patterns of substance use are examined in a sample of over 1,200 youth in a non-metropolitan region of New England. Self-reported history and frequency of alcohol, tobacco, marijuana, inhalants, pain medications, and other hard drug use was assessed for 9th and 10th grade students. Latent class analyses identified four patterns of substance use: non-users (22%), alcohol experimenters (38%), occasional polysubstance users (29%), and frequent polysubstance users (10%). Contextual risk and protective factors in the individual, family, peer, and community domains predicted substance use patterns. Youth report of peer substance use had the largest effects on substance use class membership. Other individual characteristics (e.g., gender, antisocial behavior, academic performance, perceived harm from use), family characteristics (e.g., parental drinking, parental disapproval of youth use), and community characteristics (e.g., availability of substances) demonstrated consistent effects on substance use classes. Implications for prevention are discussed from a social-ecological perspective.

Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation

OBJECTIVE

We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure.

METHOD

The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project provided data from 2,927 American Indians on the occurrence and age at onset of adversities, substance use, and substance-use-disorder symptoms.

RESULTS

The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder.

CONCLUSIONS

Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter.

Patterns of illegal drug use among an adult alcohol dependent population: results from the National Survey on Drug Use and Health

The use of illegal drugs is common in alcohol dependence and significant psychological and social consequences are associated with the concurrent use of alcohol and illegal drugs. However, little literature has examined the patterns of concurrent-drug use in alcohol dependent individuals. A latent class analysis (LCA) was used to determine whether patterns of past year illegal drug use existed in a national sample of 6059 alcohol dependent respondents of the combined 2005, 2006 and 2007 National Survey on Drug Use and Health. Multinomial logistic regression was then used to determine whether demographic variables, mental health disturbance and social consequences were predictive of drug use classes. Results of the LCA demonstrated a 5-class solution with optimal fit deduced by Bayesian Information Criterion minima. The five classes included: a close to zero probability of illegal drug use (class 1: 65%), medium marijuana, medium sedatives/tranquilizers and high analgesics (class 2: 7%), high marijuana, medium cocaine use (class 3: 21%), high probabilities of marijuana, cocaine, sedatives and analgesic use (class 4: 6%) and a high concurrent-drug use except other hallucinogens (class 5: 1%). Regression results suggest that younger age, comorbidity, engaging in deviant behaviors, sexually transmitted infection and incarceration are associated with concurrent illegal drug use in alcohol dependent individuals. Findings advocate that more intense psychiatric and drug dependence treatment resources may be needed for concurrent-drug using alcohol dependent populations and provide evidence for targeted prevention and treatment interventions.

Subtypes of depression in a nationally representative sample

BACKGROUND

Continued research efforts aim to elucidate the heterogeneity in depression. The identification of meaningful and valid subtypes has implications for research and clinical practice. Based on patterns of depressive symptomatology, this study identified a typology of depressive syndromes using data from a large, nationally representative survey.

METHODS

Analyses were based on a subsample of 12,180 respondents from the 2001-2002 Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Latent class analysis was applied to the DSM-IV 'A' criteria for major depression to identify homogenous subtypes or classes of depressive syndromes. Associations between the emergent latent classes and demographic and clinical characteristics were assessed.

RESULTS

Three clinically relevant subtypes were identified, in addition to a class who reported few depressive symptoms: severely depressed (40.9%), psychosomatic (30.6%), cognitive-emotional (10.2%) and non-depressed (18.3%). The odds of experiencing negative life events, psychiatric disorders, and having a family background of major depression were significantly higher for the severely depressed, psychosomatic and cognitive-emotional classes, compared to the non-depressed class. Several unique differences between the latent classes also emerged.

LIMITATIONS

Methodological shortcomings included: reliance on lay interviewer-administered structured interviews to determine diagnoses; basing sample selection on the endorsement of screener items; and, using measures of 'any anxiety disorder', 'any mood disorder', and 'any personality disorder' to determine psychiatric disorder prevalence rates.

CONCLUSIONS

Significant heterogeneity in depressive symptomatology exists in this U.S. sample. Profiling symptom patterns is potentially useful as a first step in developing tailored intervention and treatment programmes.

Patterns of risky behaviors associated with methamphetamine use among young Thai adults: a latent class analysis

PURPOSE

Methamphetamine (MA) is the leading illicit drug in Thailand among youth and young adults. Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine.

METHODS

We conducted a cross-sectional study in Chiang Mai, Thailand, in 2005-2006 among 1,162 street-recruited methamphetamine smokers 18-25 years of age. Data collected included sociodemographic characteristics, sexual behaviors, and drug use patterns. Latent class analysis was used to describe patterns of activities in which participants reported engaging directly after using MA. Logistic regression was used to examine univariate correlates of class membership, separately by gender.

RESULTS

Participants were 75% male with a median age of 19 years. More than half of participants reported frequent alcohol use (>or=4 days/week) and half of the sample reported smoking MA >or=2 days/ week. Three classes of activities emerged for male participants (n = 863): "work" (job related); "high-risk behaviors" (motorcycle riding, fighting, sex); and "combined" (all activities). Two classes emerged for the women (n = 299): "work" (housework) and "high-risk behaviors." "High-risk behaviors" and "combined" (men only) classes were associated with more frequent alcohol and methamphetamine use compared with the "work" class.

CONCLUSIONS

Our study found a distinct typology of behaviors associated with substance abuse among young adults in Thailand. Behavioral typologies allow a better understanding of the nuances of "risky" behaviors and might prove useful in targeting interventions.

Latent class analysis of the Child Behavior Checklist Obsessive-Compulsive Scale

The Obsessive-Compulsive Scale (OCS) of the Child Behavior Checklist (CBCL) predicts obsessive-compulsive disorder and is highly heritable. Latent class analysis (LCA) of the OCS was used to identify profiles within this 8-item scale and to examine heritability of those profiles. The LCA was performed on maternal CBCL reports of their 6- to 18-year-old children from 2 US nationally representative samples from 1989 (n = 2475, 50% male) and 1999 (n = 2029, 53% male) and from Dutch twins in the Netherlands Twin Registry at ages 7 (n = 10 194, 49.3% male), 10 (n = 6448, 48.1% male), and 12 (n = 3674, 48.6% male) years. The heritability of the resultant classes was estimated using odds ratios of twin membership across classes. A 4-class solution fitted all samples best. The resulting classes were a "No or Few Symptoms" class, a "Worries and Has to Be Perfect" class, a "Thought Problems" class, and an "OCS" class. Within-class odds ratios were higher than across-class odds ratios and were higher for monozygotic than dizygotic twins. We conclude that LCA identifies an OCS class and that class is highly heritable using across-twin comparisons.

Marijuana and Alcohol Use during Early Adolescence: Gender Differences among American Indian/First Nations Youth

This study examines the growth of alcohol and marijuana use during early adolescence among a sample of 746 Indigenous youth (aged 10–12 years at wave 1; 50.3% female) of the upper Midwest and Canada, with a special focus on potential gender differences in these patterns. Research documenting the disproportionately high rates of Indigenous substance use, coupled by our lack of understanding of gender patterns among this group—especially in very early adolescence—highlight the need for this culturally specific work. Results of latent growth curve analyses from three waves of annual data collection indicate that the females in our sample engage in alcohol and marijuana use at rates similar to or greater than their male peers. This finding counters conventional ideas of gender and substance use that place young males at elevated rates of use compared to females, and also adds to our understanding of gendered substance use patterns among Indigenous youth.

The relationship of cumulative and proximal adversity to onset of substance dependence symptoms in two American Indian communities

The proximal and distal effects of adversity on the onset of symptoms of substance dependence during adolescence were explored in two culturally distinct American Indian (AI) reservation communities (Northern Plains and Southwest). Data (N=3084) were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP). The age-related risk of symptom onset increased gradually from age 11 through age 16, remained relatively high through age 18, then declined rapidly. Both tribe and gender were related to onset of dependence symptoms; men and Northern Plains tribal members were at greatest risk and Southwest women were at particularly low risk of symptom onset across adolescence. For all tribe and gender groups, both proximal and cumulative distal experiences of adversity were associated with substantially increased risk of symptom onset. The relationship of adversity to onset of substance dependence symptoms remained strong when previous symptoms of psychiatric disorder and childhood conduct problems were considered. These findings suggest that efforts to help children and adolescents in AI communities develop constructive mechanisms for coping with adversity may be especially valuable in substance dependence prevention.

American Indian/Alaska Native alcohol-related incarceration and treatment

American Indian/Alaska Natives have high rates of alcohol-related arrests and are overrepresented in justice systems. To understand the relationship between alcohol dependence, treatment, and alcohol-related incarceration, this study queried American Indian/Alaska Natives currently in remission from alcohol dependence. Participants reported receiving 0 to 43 treatment experiences. Moreover, participants had a significantly greater number of alcohol-related incarcerations than all other treatments combined. These findings underline the importance of making alcohol treatment available within criminal justice settings.